Just a couple of years ago, Paul Krugman pointed to the Veterans Health Administration (VHA) as a "huge policy success story, which offers important lessons for future health reform." He gloated, "yes, this is 'socialized medicine.'"Similarly, a letter touted by Physicians for a National Health Program trumpeted"the success of 22 wealthy countries and our own Department of Veterans Affairs, which use single-payer systems to provide better care for more people at far less cost."How could a bloated government bureaucracy achieve such low-cost success? As we found out recently, it's by quietly sticking veterans on a waiting list and putting off their treatment for months—sometimes until the patients are far too dead to need much in the way of expensive care. Which is to say, calling it a "success" is stretching the meaning of the word beyond recognition.And, while the White House insists it learned from press reports about the secret waiting lists, Press Secretary Jay Carney acknowledges that the administration long knew about "the backlog and disability claims" that have accumulated in the VHA.This should surprise nobody. Canada's government-run single-payer health system has long suffered waiting times for care. The country's Fraser Institute estimates "the national median waiting time from specialist appointment to treatment increased from 9.3 weeks in 2010 to 9.5 weeks in 2011."Likewise, once famously social democratic Sweden has seen a rise in private health coverage in parallel to the state system because of long delays to receive care. "It's quicker to get a colleague back to work if you have an operation in two weeks' time rather than having to wait for a year," privately insured Anna Norlander told Sveriges RadioAn article in The Localnoted that "visitors are sometimes surprised to learn about year-long waiting times for cancer patients."Britain's single-payer National Health Service (NHS) is up front about wait times for care, with the organization's website promising, "you have the legal right to start your NHS consultant-led treatment within a maximum of 18 weeks from referral." Last year, the Daily Telegraphreported that "waiting lists, which have hovered around 2.5 million patients in recent years, reached 2.88 million in June, the highest level since May 2008."Why the common delays across single-payer health systems?Christopher S. Penn / FoterIt's like that sign you see in car repair shops owned by wiseasses: "Fast. Good. Cheap. Pick Any Two."Advanced medical care costs a lot of money. Delivering it quickly costs more. To the increasingly limited extent that it's allowed, American private medicine recognizes the compromises that have to be made and offers a variety of coverage at different price points—that is, you have some choice in which two you get. The British NHS also recognizes the need to compromise—and there goes "fast." (The NHS is known for holding back on "good," too, when further cost controls are needed.)The VHA has tried to pretend that compromises don't have to be made; that it can, somehow, deliver care to everybody without worrying about cost. But it faces the same lack of infinite resources as everybody else. If the VHA won't charge more for quick access to better care, fast will have to give. So we end up with secret waiting lists.The VHA also often compromises on the good part, denying that illnesses exist, or that they're military-related and therefore its responsibility.So the VA really is a good example of a single-payer, socialized health system. Just not in the way that fans of that approach mean.

Apparently, economics is hard. But some things are pretty straightforward. For example, both parties to a trade gain: it’s called “mutual benefit through exchange.” Another basic principle? Employers hire labor expecting productivity. Businesses don’t hire workers who can’t produce enough to more than cover their wages — and managers fire workers when they prove they aren’t productive enough. And yet another? Competition for trade increases the quality of products, reduces price, or both and tends to equalize prices for goods of the same quality. An appreciation of late economist Gary Becker on reason.com shows the consequence of the latter principle in a perhaps unexpected area: discrimination. A company that pays someone less than they are worth encourages worker flight, “jumping ship.” Companies that refuse to hire qualified women or minorities when they could underbid similarly productive workers (demanding higher wages) could find themselves out-competed by less discriminatory businesses. Indeed, studies suggest they could find themselves less profitable and even out of existence. Nobel Laureate Gary Becker saw this, and realized that free markets impose a check upon bigotry. Regulations that limit competition in industry also stifle gender workforce participation and increase inequality. “[C]ountries such as Japan that have avoided deregulation, shareholder capitalism, and open markets,” summarizes Elizabeth Nolan Brown, “tend to lag in both productivity and workplace gender equality.” There are many good reasons to favor free markets. They not only make us wealthier, they discourage prejudicial behavior. Competition punishes bad behavior even while it emphasizes win-win scenarios. This is Common Sense. I’m Paul Jacob. http://thisiscommonsense.com/